Programming Connection

TAHAH: Towards Aboriginal Health and Healing Program 

Vancouver STOP Project
Vancouver, British Columbia

What is the Program?

Towards Aboriginal Health and Healing (TAHAH) is a clinical and outreach-based program that supports clients to stabilize and improve their overall health. For clients who are not on HIV treatment or able to adhere to it, the program helps them to stabilize factors that affect their ability to consider, start and adhere to treatment. This support, treatment and care program works with extremely marginalized First Nation people living with HIV in the Downtown Eastside of Vancouver. It is based at the Vancouver Native Health Society (VNHS), an organization that delivers comprehensive medical, counselling and social services to Vancouver’s Downtown Eastside community.

Typically, TAHAH clients are referred to the program by a physician, nurse or support worker from the community or through another VNHS program, the Positive Outlook Program. All TAHAH clients are referred because they need a higher level of support than they are currently receiving to achieve and maintain stability in their lives. For example, a client who visits VNHS daily for lunch served in the Positive Outlook Program may be referred to TAHAH because they are not on antiretroviral therapy. Another client may be on antiretroviral therapy but may be referred to TAHAH because they are unable to maintain their methadone treatment.

The TAHAH program, which has an active case load of 25 to 30 clients, is carried out by a multidisciplinary team of individuals who work together very closely. The team includes nurses, an Elder, an intensive case manager and peer community health advocates. The peers are trained First Nation people living with HIV from the community, who help engage and support TAHAH clients.

Once engaged, clients can access a range of healthcare and social supports through TAHAH. Family doctors and infectious disease specialists provide services in clinic, and TAHAH’s nurses and case manager serve clients in clinic and through outreach.

When clients have shown that they can manage their own HIV care and have achieved stability in several other aspects of their lives, they may “graduate” from TAHAH. People will also graduate when they move out of the Downtown eastside and no longer access services at VNHS.  The program typically graduates one or two people per year.

Philosophy of care

The TAHAH program employs a holistic model of care that integrates care for the physical, spiritual/traditional, mental/emotional and social needs of their clients and staff. Program staff do not simply provide basic medical care and HIV treatment; they also recognize the power of music and art; the need for food, housing and sleep; and the need for comprehensive, individualized addiction treatment when treating HIV and other chronic and debilitating diseases.

Integrating First Nation and Western care

TAHAH works from an Indigenous context, which means that Western and First Nation knowledge systems are seen to be of equal value—and that both are viewed as necessary components of healthcare delivery to First Nation people. “The challenge,” says a VNHS physician, “is for Western practitioners to create and ensure the professional space required for Aboriginal cultural knowledge and practices.”

At VNHS, which houses TAHAH, the strengths offered by the two forms of knowledge are recognized, leading to an atmosphere of mutual respect. The senior physician at VNHS, Dr. David Tu, describes the relationship between Western and First Nation traditions at VNHS by recalling the earliest treaties recorded on Wampum belts. The Two Row belt seen below depicts the relationship between First Nations and the settlers: they are like two canoes sharing a river, each with its own way of doing things, yet equal brothers.

VNHS established this mutual respect through years of relationship building across these two communities and the use of the medicine wheel in all programs and services. The medicine wheel teaches about respect and inclusion. TAHAH engages staff and volunteers who value both forms of knowledge and who are committed to being guided by the medicine wheel.